Lasers, injectables, chemical peels and topical creams—they’re just the latest weapons in our ever-expanding arsenal against aging.
While watching “The Oprah Winfrey ShowâÂ€Â one day, 51-year-old Sandy Wright heard about a new skin treatment called Thermage. It sounded magical: a high-tech tool that could tighten skin around the face and neck without surgery.
She took the plunge. It worked.
“The beauty of it,âÂ€Â says Wright (not her real name), “is that there’s no downtime. The treatment took about 45 minutes to an hour, and there was no aftermath. We even went Christmas shopping afterward!âÂ€Â
In a world of high-tech this and laser that, beauty treatments promising to peel away the years are multiplying faster than you can say “bring me the Botox.âÂ€Â And minimally invasive nonsurgical procedures are more popular than ever, jumping 51 percent between 2003 and 2004, according to national statistics from the American Society for Aesthetic Plastic Surgery. Of the nearly 11.9 million cosmetic procedures performed in the United States in 2004, nonsurgical treatments represented 82 percent of the total.
Although we can’t throw out the Botox with the bath water—it’s still the most-performed nonsurgical cosmetic procedure in this country—there are all kinds of new weapons with which to wage the war on wrinkles, brown spots and other dermatological demons. What’s more, these new treatments are being paired up with the old, creating an ever-widening smorgasbord of options and, frequently, a “better together than apartâÂ€Â scenario.
Here’s a peek at what’s new:
Talkin’ ’bout Thermage
Although not everyone is using it yet, it seems everyone’s talking about Thermage. Known by the trade name ThermaCool, the treatment uses a hand-held instrument to transmit radio-frequency energy through the skin, heating the underlying soft tissues while the top layer stays cool. “It causes the underlying collagen to contract and tighten,âÂ€Â explains Suzanne Kilmer, M.D., a Sacramento dermatologist whose Laser & Skin Surgery Center was the site of the initial Food and Drug Administration clinical trial. “It’s the only thing we have that tightens deep without any surface changes.âÂ€Â The downside? “Ten to 15 percent of the time, people don’t see improvement,âÂ€Â says Kilmer, “though if you biopsy them, everybody has tighter collagen.âÂ€Â The upside is that the pain factor that some patients once complained about has been reduced. “We now do multiple passes and it’s not as high of an energy, so it’s not as painful as it used to be, and it’s also more effective,âÂ€Â says Kilmer.
Valium also helps, notes Wright, who trekked in from Grass Valley for the treatment with Kilmer. “The medication helped, and it’s also possible I have a high threshold for pain,âÂ€Â she admits. “It was painful on one side of my face, but not intolerable, and I couldn’t even feel it on the other side.âÂ€Â It was only during the “pulsesâÂ€Â from the ThermaCool device that she felt anything, Wright says. “When it was done, it was done. Afterward, nothing. No side effects, no downtime, no hiding.âÂ€Â Wright paid $3,000 for a full face and neck treatment, and says she would do it again. “It really did tighten my sagging skin, and even firmed up the crepeyness in my neck,âÂ€Â she says. Although her husband claims he saw an immediate improvement, changes appear more gradually for most patients.
But not everyone is gung-ho about Thermage. “It’s an interesting method to stimulate collagen in the skin, but the data shows only some patients show modest improvement,âÂ€Â says Emil Tanghetti, M.D., of the Center for Dermatology and Laser Surgery in Sacramento. “Some caution is advised, because whenever you deal with something new, you’re dealing with a big ‘maybe.’âÂ€Â
Restylane to the Rescue
Some newer treatments, however, have earned a universal thumbs-up. Restylane, which has begun to take collagen’s place as the filler of choice, is one of them. “I do prefer Restylane to collagen,âÂ€Â says Sangeeta Marwaha, M.D., a board-certified dermatologist for Kaiser Permanente in South Sacramento. She’s not alone: The use of Restylane and other hyaluronic acids such as Hylaform jumped a whopping 659 percent in 2004, according to the ASAPS. “The fact that it lasts longer than collagen is a great plus, and because it is a true bulking agent, I find you can work on larger wrinkles and get better improvement,âÂ€Â says Marwaha. “It also works well for those who want to truly fill their lips.âÂ€Â At anywhere from $450 to $900 a pop, Restylane can run nearly twice the cost of collagen, but it’s also twice as long lasting, possibly more—anywhere from six to 12 months, compared to collagen’s two or three.
Vicki Rowden, a product specialist for Tanghetti, had long wanted to do something about her nasolabial folds (the creases that run from the nose to the corners of the mouth) and the “marionetteâÂ€Â lines around her mouth. She’d had plenty of opportunities to use collagen, but had avoided it, largely because she did not want to undergo skin allergy testing and didn’t like the idea of being injected with bovine fat. Restylane, which is made of nonanimal hyaluronic acid, was the perfect alternative. “I liked the results,âÂ€Â says the 50-year-old Rowden, who had the filler injected around the edges of her lips as well as the aforementioned areas. “The changes are subtle, but I think when you get to a certain age and you have deep smile lines, fillers such as Restylane can puff up the skin so the lines are not so deep.âÂ€Â If you want a faster fix, however, collagen (now also available in human as well as bovine form) still may be your best bet: Restylane can cause mild swelling, bruising, tenderness and, potentially, several days to a week of downtime. “With collagen, you just put your makeup on and you’re out—you could go to a party,âÂ€Â notes Marwaha.
Hylaform is another new filler getting a lot of press, but its usage seems to be limited, at least in Sacramento. “We use a little bit of it because it’s less painful than Restylane, but we still use mostly Restylane, because it’s probably safer, and lasts a little longer than Hylaform,âÂ€Â says Kilmer. Though Hylaform and Restylane are both made of hyaluronic acid, Hylaform, unlike Restylane, is derived from rooster combs. “You do have a potential for allergy, though apparently the incidence is very low,âÂ€Â she adds. Both Hylaform and Restylane cause temporary swelling, and the cost is about the same.
Sculptra Fills a Void—Literally
Also new is Sculptra, a synthetic substance (poly-L-lactic acid) that has been FDA-approved to fill and restore the hollowed cheeks of AIDS patients who suffer from facial lipoatrophy (fat loss). Sculptra also can serve as a “plumper-upperâÂ€Â for people like Rowden, who want to fill nasolabial folds and other lines. Roughly a year after she was injected with Restylane, Rowden tried Sculptra. “I was trying to achieve the same result as with the Restylane,âÂ€Â she explains, “but Sculptra is different in that it helps to stimulate collagen growth.âÂ€Â She had her first treatment around the time of our interview, and was anticipating a few follow-ups. “There was virtually no pain with the injections,âÂ€Â Rowden says, although the numbing agent probably helped.
Results are not immediate with Sculptra; rather, the skin gradually thickens. Studies show that results last up to two years for most patients.
And in case you haven’t had your fill of fillers, here’s one more for the road: For those deep facial creases (especially nasolabial folds), there’s now Radiesse (originally called Radiance), a semipermanent solution said to last from two to five years. Made of microscopic calcium particles (hydroxylapatite), the injectable substance already is used for dental surgery, vocal cord augmentation and other medical purposes, but its effectiveness as a cosmetic filler still is being tested. Kilmer was conducting clinical trials at the time of this writing.
Updates on Old Treatments
While fillers may come and go, it’s an oldie but goodie—Botox—that’s still at the top of the heap. That’s because it does something no other injectable can do: It blocks muscles, preventing skin from wrinkling. “Everything else we have works on static lines, but Botox is the one thing that improves lines in motion,âÂ€Â says Marwaha. “Comparing Botox to other antiaging techniques is like comparing apples and oranges.âÂ€Â In addition to treating the usual suspects—crow’s feet, frown lines—Botox (Botulinum toxin type A) is now being used in more new ways than ever, such as minimizing horizontal neck lines, lifting eyebrows and turning up downturned mouths. (“One of the things that ages people is that downturned mouth,âÂ€Â notes Kilmer.) Combination therapies also are a hot trend, such as using Botox or Restylane with laser treatments, each complementing the other: While Botox and Restylane specifically attack wrinkles and lines, lasers take a more general sweep, improving the overall complexion.
Lasers, by the way, remain a top treatment of choice, and not just to rejuvenate aging skin: They also are used to remove hair, tattoos, brown spots, veins and other undesirables. “People think there’s one laser,âÂ€Â says Kilmer, “but in our office we have 29, and they’re all completely different.âÂ€Â A word to the wise: Don’t overwhelm yourself (as I did) with the never-ending list of brand names and varieties; just know there’s a huge difference between ablative (the kind that can put you out of commission for a week) and nonablative (noninjuring), and go to a well-trained doctor who will choose the right laser for you.
Lunchtime laser treatments—meaning the lighter, nonablative variety—continue to grow in popularity, says Marwaha. “I’m seeing more interest in nonablative lasers because you can have the treatment during your lunch hour and go back to work,âÂ€Â she says. “I think the general trend is that people want improvement with no downtime.âÂ€Â Treatments take about 20 minutes and should be repeated every six or eight weeks for three to six months for real improvement in skin tone, texture and pigmentation.
Kilmer, on the other hand, has noticed a rising demand for the heavier-duty ablative resurfacing. “I would say it’s one of the biggest things that’s coming back—it’s on the upswing,âÂ€Â she says. For those who really want to reverse the clock, she says, it’s definitely the way to go. “In the end, there’s no question that you look five, maybe even 10 years younger,âÂ€Â she says. “It’s still the gold standard for taking off all wrinkles and brown spots.âÂ€Â But nothing good comes easy (or cheap), and neither does this: Expect to shell out about $3,000 to $5,000 and to hide out for at least a week, soaking your skin (which will be red and swollen) with a water-and-vinegar solution every couple of hours during recovery.
A New Alternative to Microdermabrasion
Microdermabrasion—in which dead skin particles are rubbed off and vacuumed away to stimulate cell growth—probably will always be a mainstay. But now there’s Vibraderm, which Kilmer describes as an “easier, fasterâÂ€Â alternative. While microdermabrasion uses gentle vacuum suction to remove dead and damaged skin cells, Vibraderm, true to its name, is a tool that “vibratesâÂ€Â the cells off. “People love it, because it takes off those outer cells so your skin feels really smooth,âÂ€Â Kilmer says. The cost? Around $150 for full face and neck—the same as microdermabrasion.
Topicals and Peels
Also in the “newâÂ€Â category is a topical called Prevage, which was just entering the market at the time of this writing. Containing the antioxidant idebenone, Prevage is being touted as a “potent but nonirritatingâÂ€Â prescription cream that will reduce free-radical damage and halt collagen breakdown. But no one we spoke to was using it yet, so the jury’s out.
“Some of the newer products seem to make theoretical sense,âÂ€Â notes Tanghetti, “but if you’re looking for efficacy, go for the things that are proven.âÂ€Â Vitamin A derivatives (retinoids) such as prescription-only Retin-A, Renova and Avage have a proven track record for boosting collagen production, making them a cornerstone of good skin care. (Over-the-counter retinol is another option.) “If you’re looking for something noninvasive to help the photodamage,âÂ€Â he says, “retinoids are clearly No. 1, because they work.âÂ€Â
Glycolic acids also have long proved effective, Tanghetti says, as a powerful means of exfoliating and renewing the skin, fighting wrinkles and smoothing out pigmentation. Glycolics are found in peels (including at-home peels), creams, facial washes, toners and other products. Lactic acid peels are a newer and less irritating alternative, notes Marwaha, and may be particularly good for traditionally hard-to-treat darker skin tones.
Skin type determines the strength and type of peel to use, says Robert McLaughlin, M.D., a facial plastic and reconstructive surgeon and medical director of Kaiser Permanente’s cosmetic surgery services. Although peels are not recommended for all skin types, McLaughlin notes that they can safely be used on a wider range of skin types than can ablative lasers. “I often recommend chemical peels instead of laser resurfacing because they work on a wider variety of skin types and are less expensive,âÂ€Â he says. And how: Medium and deep chemical peels run around $700 to $1,000, versus laser resurfacing’s $4,000-ish price tag. (Light “lunch hourâÂ€Â peels are about $100 to $200.)
Your Best Defense
Skin care trends may come and go, but one remains constant: A good sunscreen is still your single best defense against aging.
“The No. 1 thing I tell my patients is that a good sunscreen is worth its weight in gold,âÂ€Â says Marwaha. Brand names aren’t as important as ingredients: Look for broad-spectrum (both UVA and UVB) protection, minimum SPF 15, with zinc oxide or titanium dioxide. “The better your sun protection, the less you age,âÂ€Â Marwaha adds. “If you use a good sunscreen daily, you’ll be less inclined to need more aggressive forms of treatment down the road.âÂ€Â
“Long-term care is the goal,âÂ€Â concurs Tanghetti. “You could come in for a couple of treatments, and you’ll stimulate growth and repair. But unless you continue with something like a retinoid and protect yourself from further damage by using a good sunscreen, what’s going to prevent this from coming back again? How are you going to fight it over the long haul?âÂ€Â
Need more information about cosmetic procedures or a referral to a qualified doctor? The following resources may help.
American Society for Aesthetic Plastic Surgery (562) 799-2356 (general); (888) 272-7711 (referrals); surgery.org
American Society for Dermatologic Surgery (847) 956-0900; asds.net
American Academy of Dermatology (888) 462-DERM (3376); aad.org
American Society for Laser Medicine and Surgery (715) 845-9283; aslms.org
New Beauty magazine newbeauty.com
Something To Smile About: Cosmetic Dentistry’s New Frontiers
A beautiful smile has star power—and not just for Tom Cruise or Julia Roberts. For everyone.
Once the province of the Hollywood elite and the genetically blessed, a megawatt smile now is available to virtually anyone who can afford it, thanks to recent advances in cosmetic dentistry. “The past two years have been just phenomenal,âÂ€Â says Arthur Kwan, D.M.D., a local cosmetic dentist. “Business is booming, and I think it’s only going to get more out of control.âÂ€Â
It’s all part of the antiaging trend—the same phenomenon that’s driving otherwise reasonable midlifers to slather soy serum on their skin in the quest to dip into the eternal fountain of youth.
“A new smile can make you look years younger,âÂ€Â says Kwan, who runs his Rocklin practice, Nu Smile Dental Group, with his wife, Sally Hsu, D.D.S. “I’m seeing a lot of people in their 40s and 50s whose children are finished with college and who now want to do something for themselves. These are the people who are coming in wanting extreme makeovers.âÂ€Â
In fact, the popular TV show “Extreme MakeoverâÂ€Â is one of the catalysts dentists point to when they discuss the cosmetic-dentistry craze—a craze estimated to constitute $15 billion of the $70 billion-a-year U.S. dental industry. “When I saw Bill Dorfman, the dentist on ‘Extreme Makeover,’ during a recent visit to Hollywood, I thanked him for helping out my practice,âÂ€Â says Roseville’s John P. Hansen, D.D.S. “I’m sure every cosmetic dentist out there would say the same thing.âÂ€Â (They did.)
Zoom! Goes Boom
It was by watching “Extreme MakeoverâÂ€Â that millions of pearly-white wannabes first heard about the Zoom! whitening treatment, which has since gone gangbusters. True to its name, Zoom! offers whiter teeth in a flash—about an hour and a half in the dentist’s chair, as compared to conventional at-home bleaching trays, which you wear overnight for several weeks for similar results.
“If it’s Tuesday, and you’ve got a wedding to go to on Friday, Zoom! is a really good way to go,âÂ€Â says Hansen. “It’s kind of a time-versus-money thing.âÂ€Â (Home bleaching usually runs about half the cost of in-office bleaching.)
Here’s how it works: A hydrogen-peroxide whitening gel is applied to the teeth, then activated by a specially designed light. A five-minute fluoride treatment completes the process. The result: teeth that are six to 10 shades lighter—and it’s pain-free (though some may experience temporary tooth sensitivity). The cost? Anywhere from $450 to $800 for the full-mouth treatment. Results generally last nine to 12 months, but a little touch-up should bring your teeth back to the original shade, Kwan says.
Next up: the “new and improvedâÂ€Â Zoom2, which was being readied for release as this article went to press. “With Zoom2, they’re knocking the time down to as little as 45 minutes, with 67 percent less tooth sensitivity than the original Zoom!,âÂ€Â says Kwan.
The Big Guns
While Zoom! and other bleaching options work well for those who simply want whiter teeth, it’s not a solution for people who need a total smile makeover. For teeth that are small, misshapen, cracked, worn or too dark to respond to bleaching, it may be time to break out the big guns (and the big money) for porcelain veneers.
“Veneers are getting better all the time,âÂ€Â says Kwan. Unlike bulky porcelains of the past, today’s veneers are ultrathin, meaning less tooth removal. They also look more natural than ever, says Kwan, who raves about the latest line from Empress, a premier name in porcelain. “The new version of Empress just came out about two months ago, and it kicks the porcelain up a notch,âÂ€Â he says. “There’s more of a translucence, allowing light to travel into your tooth, so it looks like it’s part of you. They look so natural that even some dentists can’t tell the difference between the veneer and the real tooth.âÂ€Â
The veneering process typically is completed in two appointments. After preparing the teeth by grinding them to allow for the added thickness of the veneer, an impression is taken, from which the veneers are precisely crafted. On the second visit, the veneers (which are like little jackets) are applied to the teeth with an adhesive bond and high-intensity light. Although some light drilling and grinding are involved, the procedure generally isn’t painful, though the cost may be: Veneers run $1,200 and up per tooth.
For most people, though, it’s worth every penny—even if it does come straight out of the consumer’s pocket. (Cosmetic procedures aren’t covered by insurance.)
“Getting veneers changed my life,âÂ€Â says a 30-something interviewee who asked to remain anonymous. “I went through my teens and 20s with dark tetracycline-stained teeth, and it was hugely embarrassing. I would always smile with my lips closed or put my hand over my mouth. I literally ran from cameras.âÂ€Â Although she’s still paying off the credit-card bill of nearly $8,000, her six shiny new front teeth have transformed her looks and boosted her self-esteem. “My only worry now is whether my teeth look abnormally white!âÂ€Â she laughs. “But better white than gray.âÂ€Â
Porcelains also are praised for their strength and durability, a primary reason why they’re often preferred to composite resin bonding (in which an enamel-like material is applied to the tooth’s surface, sculpted into shape, hardened, then polished), which is less long lasting, but also less expensive (about half the price). “Porcelains usually last between 10 to 20 years, but they can even last a lifetime if you’re one of those individuals who is pretty easy on your teeth,âÂ€Â says Hansen, who provides a “trial smileâÂ€Â—a temporary mold—for patients to wear before the actual veneers are made. “The trial smile is an exact replica of what your new veneers will look like,âÂ€Â he explains. “You go home with your trial smile, wear it for about a week, and when you come back, you can give me feedback on what you like and don’t like, and I’ll work on your veneers until I get them absolutely perfect . . . until you say ‘I love them.’ That way, there are no surprises when you get your permanents.âÂ€Â Many—but not all—cosmetic dentists provide a similar service, so be sure to ask.
Implants, Braces and Bridges Get Better
Like veneers, implants are now better than ever, notes David L. Duke, D.D.S., of Duke Dental in Roseville, who has been on the cutting edge of cosmetic dentistry for more than 18 years. An alternative to dentures, implants provide a stronger, more attractive means of replacing missing or lost teeth. “Implants restore mouths,âÂ€Â says Duke, “and they’re so much easier now to replace and restore. If someone is missing teeth, they’re an ideal way to get function back, a smile back and even their confidence in their ability to chew.âÂ€Â Costs vary widely—anywhere from $1,450 to $2,600 per tooth.
Braces, which have become downright fashionable since the dreaded “metal mouthâÂ€Â days of yore, also are ever-evolving—and ever-invisible. Sales of Invisalign, a night guardlike brace that uses a series of thin, clear plastic aligners, grew by a whopping 75 percent in 2003. SureSmile, which uses tooth-colored wire that is preprogrammed to make sequential changes over time, is another new option.
And though they hardly sound sexy, even bridges have taken on added allure with new products such as P2Z (porcelain to zirconium). “Bridging used to be accomplished with long bridges—say when you’re missing three, four, five teeth—so people would get stuck with a bridge with metal underneath it,âÂ€Â explains Kwan. But with P2Z, Kwan says, a special porcelain is bonded to a zirconium framework, negating the need for unsightly metal. It also appeals to the holistically inclined who prefer not to have any metal in their mouth, says Kwan.
Laser Gum Contouring
Another hot trend in cosmetic dentistry is laser gum contouring, a technique Hansen says he now uses on almost every patient. “Some people have very gummy smiles, so the goal is to show more teeth, not more gum,âÂ€Â he says. The procedure is actually quite simple: After numbing the area, the practitioner uses a special laser to even out and shape the gumline. There’s no bleeding, no stitches, and it typically heals in a few days.
“It’s just a higher level of detail we look at when we’re creating a great smile,âÂ€Â Hansen explains. If the gumline on your two front teeth is uneven, for example, it appears as if the teeth are different lengths. But with gum contouring, Hansen says, the gumline can go from asymmetrical to symmetrical, bringing everything back into balance.
“We’re not just putting the emphasis on teeth anymore,âÂ€Â he says. “The trend is to look at the bigger picture—skin tone, facial structure—for a more complete makeover.âÂ€Â
Treating the Whole Person
Kwan, who specializes in neuromuscular dentistry as well as cosmetics, is among a new and growing breed of dental professionals who take a “whole personâÂ€Â approach to the craft.
“When we take care of the smile, we’re often solving functional problems as well, such as when there are bite problems that throw the jaw out of alignment,âÂ€Â he explains. “By placing the jaw in optimum position and realigning the teeth, other problems, such as headaches, neck pain and back pain, will often go away.âÂ€Â Kwan says a number of his patients were able to cut back on pain medication or chiropractic treatments once their dental problems were solved.
“It’s like nonmainstream work,âÂ€Â says Kwan. “We’re cutting a different edge here.âÂ€Â
For more information about dental procedures or a referral to a cosmetic dentist, the following resources are a good place to start.
American Academy of Cosmetic Dentistry (800) 543-9220; aacd.com
American Academy of Esthetic Dentistry (312) 321-5121; estheticacademy.org
American Dental Association (312) 440-2500; ada.org
American Society for Dental Aesthetics (800) 454-ASDA (2732); asdatoday.org
My New Smile mynewsmile.com